Study Summaries

T = treatment, C = control.

T>C = treatment had better outcomes, C>T = treatment had worse outcomes, T~C = no significant difference between groups

Reference / Participants / Study characteristics
Author(s) / Year / Intervention / N / Characteristics / Outcome measures / Design / Results
Ashford et al. / 2008 / Individuals diverted after being convicted were enrolled in a cognitive-behavioural program targeting criminal attitudes. It is a generic program that was modified for offenders with mental disorders. The comparison group received inpatient mental health services as they were too far in the criminal justice process to be referred for the program. / T = 47
C = 29 / Appear to be low risk sample; females were over-represented. / Arrest, violent arrests, breaches / Study quality issues; alternate treatment / T>C on aggregate, arrest and violent arrest
C>T on breaches
Belfrage / 1991 / Individuals found “equivalent to insane” treated in psychiatric hospitals were compared to “non-equivalents” who were incarcerated. Very little information about the exact nature of treatment is provided. / T = 188
C = 132 / Large number of violent crimes and diagnoses of psychopathy. Some issues with definitions of categories make comparisons difficult. / Arrest / Study quality issues; control group / T>C
Broner et al. / 2004 / 8 diversion sites were analyzed in this multi-site trial, with considerable variability between some sites. The program targeted individuals with co-occurring mental health and substance use disorders. Some programs were pre-booking/charge, while others were post-charge. / T = 971
C = 995 / Women were over-represented; large number of psychotic disorders in sample as well.
Dual-diagnosis population is related with increased risk. / Arrest, jail days / Good study quality; control group / T>C on aggregate and jail days
T~C on arrests
Chandler & Spicer / 2006 / All participants received an integrated substance use and mental health treatment program while incarcerated. The treated group received intensive follow-up services for up to 2.5 years post-release from the same provider as the inpatient component. High fidelity ratings are reported. / T = 103
C = 79 / Dual-diagnosis population is related with increase risk. Women and psychotic disorders over-represented. / Arrest, conviction, jail days / Good quality; Control group / T~C on aggregate, jail days, and conviction
T>C on arrests
Christy et al. / 2005 / Mental health court which accepts only minor offences following identification of potential clients by police, jail, family, consumers, or any interested party. / T=116
C=101 / Lower risk clients by virtue of only accepting minor offences; women over-represented. / Arrest, jail days, time to / Study quality issues; control group / T~C on all measures
Cosden et al. / 2005 / Mental health treatment court with an assertive community treatment team attached to the court. Due to grant requirements a time-limit was imposed contrary to traditional ACT model. / T = 110
C = 77 / Women over-represented. / Arrest, conviction, jail days / Study quality issues; control group / T>C on jail days
T~C on all other measures
Hoff et al. / 1999 / Treated group was diverted out of jail into mental health treatment; control group was eligible but not diverted. No additional information about treatment as sample is a retrospective cohort. / T = 314
C = 124 / Low-level crimes; effect was predominantly from the higher severity crimes within those considered. / Jail days / Study quality issues; control group / T>C
Khodayarifard et al. / 2008 / Cognitive behavioural group and individual sessions offered in jail setting with aim of improving mental health stability. / T = 13
C = 16 / Fairly old sample (M = 47), with long sentences; this would typically be associated with lower risk. / Conviction / Study quality issues; control group / T>C
McNiel & Binder / 2007 / Mental health court participants – little information provided on the actual interventions aside from data on the status of the participants. / T = 170
C = 8067 / Selection biases for treated group (psychotic disorders overrepresented, and mood disorders under-represented). / Arrest, violent arrest / Study quality issues; control group / T>C on all outcomes
Moore & Hiday / 2006 / Mental health court compared to traditional court participants. Completion of mental health court requirements and level of supervision were found to further reduce re-arrest rates for mental health court participants. / E = 82 C= 183 / Comparison group was identified by the judge responsible for the court as individuals who would have been eligible for the mental health court (based on his knowledge of the client’s history) had it been in existence at that time. Control group was significantly younger, with a greater proportion of African Americans, a higher average prior offence severity score, and averaged more days in jail in the year prior to the current arrest. / Arrest / Study quality issues; control group / T>C
Morrissey et al.– King county / 2007 / Intervention was the receipt of Medicaid benefits on recidivism. Data were also tracked on outpatient service utilization. / T = 3346
C = 1843 / Sampling units were releases; therefore there were multiple releases per individual. Risk increases with additional offences. / Arrest, time to / Good study quality; control group / T>C on all outcomes
Morrissey et al.– Pinellas county / 2007 / Intervention was the receipt of Medicaid benefits on recidivism. Data were also tracked on outpatient service utilization. / T = 1877
C = 542 / Sampling units were releases; therefore there were multiple releases per individual. Risk increases with additional offences. / Arrest, time to / Good study quality; control group / T>C on arrests,
T~C on aggregate and time to
Muller-Isberner / 1996 / Outpatient mental health care following NGRI verdict, with weekly contact both at hospital, but also in the client’s residence. / T = 56
C = 67 / Slight over-representation of psychotic and cognitive disorders; no women. / Conviction, breach / Study quality issues; control group / T>C on aggregate
Rice et al. - non psychopaths / 1992 / Therapeutic community with minimal staff involvement and structure. Peer operated programming, with intensive group therapy for up to 80 hours weekly, with the goal of developing empathy and responsibility for peers. / T = 114
C = 90 / Treated sample was higher risk with more previous hospitalizations, less likely to have been married, less personality disorders, more diagnoses of psychosis, and lower alcohol abuse scores. / Conviction, violent / Study quality issues; control group / T>C
Rice et al.– psychopaths / 1992 / Therapeutic community with minimal staff involvement and structure. Peer operated programming, with intensive group therapy for up to 80 hours weekly, with the goal of developing empathy and responsibility for peers. / T = 52
C = 29 / Higher risk sample due to high psychopathy scores, but matched on this dimension.
Treated sample was higher risk with more previous hospitalizations, less likely to have been married, less personality disorders, more diagnoses of psychosis, and lower alcohol abuse scores. / Conviction, violent / Study quality issues; control group / T~C
Rivas-Vazquez et al. / 2009 / Comparison of a relationship-based diversion program for homeless OMDs to a traditional diversion program. / T = 78
C = 78 / Full sample (T = 151) was not matched on prior criminal history, therefore only a subsample of the treated group was included in the data used to calculate effect sizes. / Arrest / Study quality issues; alternate treatment / T>C
Sacks et al. / 2008 / Modified therapeutic community to meet the specific needs of offenders with co-occurring substance use disorder, compared to the usual intensive outpatient treatment program offered, which follows a cognitive-behavioural approach. / T = 163
C = 151 / Entirely women sample. Large proportions with mood and anxiety disorders and trauma histories. / Arrest / Good study quality; alternate treatment / T>C
Sacks et al. / Sullivan et al.a / 2004/2008 / Modified therapeutic community with the option of post-release aftercare for the treated sample, compared to usual mental health services offered within the institution with no aftercare. / T = 75
C = 64 / Co-occurring substance use disorders increase risk of re-offending for both groups. No women in this study. / Arrest, conviction, time to / Good study quality; alternate treatment / T>C on aggregate and conviction. T~C on arrest and time to
Shafer et al. / 2004 / Post-booking jail diversion program for individuals with co-occurring mental health and substance use disorders. Post-booking diversion options included release on conditions, summary probation or deferred prosecution. / T = 124
C = 78 / Women and mood disorders over-represented; little other information. / Arrest / Study quality issues; control group / T~C
Silver et al. / 1989 / Outcomes for a group of insanity acquittees were compared to a group of inmates who were transferred during their sentence for acute mental health treatment. / T = 127
C = 135 / Sample primarily diagnosed with psychotic disorder; mood disorder under-represented. No information on gender breakdown, however, presume it is all male. / Arrest, time to / Study quality issues; alternate treatment / T>C on aggregate and arrest
T~C on time to
Solomon & Draine / 1995 / Assertive community treatment case management model compared to treatment as usual (referral to a community mental health centre). / T = 71
C = 23 / Considerable attrition in the sample; proportion of women appears representative. Little information on the sample. / Arrest / Study quality issues; alternate treatment / T~C
Taylor / 2005 / Linkage program to promote access to services, including medication, mental health and substance abuse treatment, housing, legal, financial and peer support. / T = 106
C = 100 / Mood and psychotic disorder rates are high (above 50% for mood, and approx 30% psychotic). Substance use disorders seem low. / Arrest, conviction, jail days / Good study quality; control group / T~C on all measures
Tellefsen et al. / 1992 / Test of two models for treatment of NGRI clients. One model is a regionalized model, where clients are transferred from a secure forensic hospital to a less secure hospital prior to release, versus a non-regionalized model with transfer straight to the community from the secure hospital. Regionalized model was considered the treated group, and non-regionalized as the comparison group. / T = 24
C = 36 / Regional group was higher risk (more previous hospitalizations, more likely to be unskilled, more previous arrests, etc.).
Gender breakdown not provided, therefore likely all male. / Arrest, breach, time to / Study quality issues; alternate treatment / C>T on breach.
T~C on all other measures, though C>T (non-significant)
Theurer & Lovell / 2008 / Intensive case management service that sought to promote inter-agency cooperation and integration of services. Obstacles noted in the first year, including stereotypes towards OMDs and underestimating rates of substance use that had to be overcome. / T = 64
C = 64 / Women over-represented; slightly more psychotic than mood disorder diagnoses. / Conviction / Good study quality; control group / T>C
Van Stelle et al. / 2004 / Clients participated in a 9-12 month therapeutic community within the prison providing integrated substance use and mental health services. / T = 70
C = 21 / All male sample; co-occurring substance use increases risk. / Conviction / Study quality issues; control group / T~C
Wilson et al. / 1995 / Assertive community case management services to link offenders with services and assist with community functioning with the goal of extending the length of time in the community for OMDs with multiple needs. / T = 14
C = 17 / All male sample; clients had to be defined as “difficult, chronic multi-system users”. / Jail days, time to / Study quality issues; control group / T>C on time to and aggregate measure
T~C on jail days
Zlotnic et al. / 2009 / Women-specific intervention within the institution in a voluntary substance use treatment inpatient unit with a requirement to attend upwards of 30 hours per week of substance use programming. The intervention provides skills to manage substance use and PTSD symptoms. A follow-up component upon release is also offered to participants. / T = 27
C = 22 / All female clients with substance use disorders and PTSD. Intervention tailored to this specific group, which is relatively homogenous compared to other samples. / Conviction / Good study quality; control group / T>C